gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Outline

Fractures often are caused by a fall. It’s mostly the elderly who fall because postural strategies change with increasing age. About 30% of the elderly – above the age of 65 – fall at least once a year. With increasing age this ratio further increases. Ninety percent of the hip fractures are induced by a fall. However, falls do not only break bones but self-confidence as well. About half of all fallers are afraid of falling again and about one quarter of them restrict their daily activities because of this fear.

Most falls experienced by eldery people result from multiple aetiological factors. However, about 15% of falls are caused by a single identifiable endogenous factor like medical problems or impairments in strength, endurance, balance or gait. Another 15% of falls are caused by an environmental factor such as door sills, stairs, poor lightening.

The effectiveness of different interventions for preventing falls in older people living in the community is summarized in a Cochrane-Review. Multiple-component group exercises reduce the risk of falling, individually prescribed multiple-component home-based exercise is even more effective and Tai Chi reduces the risk of falling by 35%. A multifactorial intervention as well as the withdrawal of psychotropic drugs, both reduce the rate of falling. The supplementation of vitamin D is only effective in persons with a very low serum level and home safety interventions in persons with especially high risk of falling. The rate of falls may also be reduced by the withdrawal of psychotropic drugs, and if necessary a pacemaker or eye cataract surgery. There is some evidence that fall prevention strategies can be cost saving. Sometimes hip protectors are recommended to reduce the risk of a hip fracture in the course of a sideways fall. However, the compliance is not very high and study results are diverse.

Of course, identifying persons with a high risk of falling is important. A rough screening is possible by asking the patient if he/she had fallen within the last year. In the case of difficulties with gait or balance further evaluation is necessary.

Depending on the individual problems parts of the multifactorial interventions described above may help reducing the person’s risk of falling.